Consumer rights and responsibilities

Definition

Alternative Names

Health care consumer's rights; Rights of the health care consumer

Information

In March 1998, the Advisory Commission on Consumer Protection and Quality in the Health Care Industry issued its final report, which included the Consumer Bill of Rights and Responsibilities. The Commission was appointed by President Bill Clinton, and co-chaired by Donna Shalala, Secretary of the Department of Health and Human Services.

The purpose of the Bill of Rights is:

To build up consumer confidence in the health care system, by making it easy for consumers to be involved in their own health care.

To strongly support the importance of a good healthcare provider and that of a good provider-patient relationship.

To emphasize and support the importance of the consumers' role in making sure they have rights and responsibilities with regard to health improvement.

The Consumer Bill of Rights was developed by the federal government. This has been used by many health plans, including the federal-government-sponsored health plans.

Consumer Bill of Rights

I. Information Disclosure

You have the right to receive accurate and information you can understand about your health, treatments, health plan, health care providers, and health care facilities. If you speak another language, have a physical or mental disability, or just don't understand something, you will be helped so you can make informed health care decisions.

II. Choice of Providers and Plans

You have the right to choose your health care provider, within your health plan.

III. Access to Emergency Services

If you have severe pain, an injury, or sudden illness and you are concerned that you could be seriously ill, hurt, or could die, you have the right to get emergency services whenever and wherever needed, to be seen by a doctor and get services, even if you don’t ask your health plan first, and you will not be charged a penalty.

IV. Participation in Treatment Decisions

You have the right to know all your treatment options, even if they are not covered by your health plan, and make decisions about your care. Parents, guardians, family members, or others that you choose can represent you if you cannot make your own decisions.

V. Respect and Nondiscrimination

You have the right to considerate, respectful care, and not be discriminated against, by your doctors, other health care providers, or health plan representatives.

VI. Confidentiality of Health Information

You have the right to talk in private with health care providers and to have your health care information protected. You also have the right to review and copy your own medical record and ask your doctor to make corrections your record if it is not accurate, complete, or has information that does not relate to your health care.

VII. Complaints and Appeals

You have the right to a fair, fast and objective review of any complaint you have against your health plan, doctors, hospitals or other health care personnel. This includes complaints about waiting times, hours available, health care facilities, and the conduct of health care personnel.

Consumer Responsibilities

In addition to listing consumer rights for health care, the Advisory Commission on Consumer Protection and Quality in the Health Care Industry also listed the responsibilities of consumers. These are ways the consumer can work together with health care providers to get the best quality health outcome.

Doing your best to get well and stay healthy, with healthy habits, such as exercising, not smoking, and eating a healthy diet.

Tell your health care providers the information they need to know, and clearly communicate what you want and need.

Be involved with your health care providers when making your health care decisions.

Work with health care providers in developing and carrying out treatment plans you all agree upon.

Use the health plan's internal complaint and appeal process to address concerns that may arise.

Avoid knowingly spreading disease.

Recognize of risks and limits of the science of medical care and that health care providers are human and can make mistakes.

Be aware of a health care provider's need to fairly provide care to other patients and the community.

Learn about your health plan coverage and health plan options (when available) including all covered benefits, the limits, what isn’t covered, the rules regarding use of information, and how to appeal coverage decisions.

Show respect for other patients and health workers.

Make a good-faith effort to pay your health care bills.

Follow procedures of the health plans and health care providers.

Report wrongdoing and fraud to the right resources or legal authorities.

References

Version Info

Linda J. Vorvick, MD, Medical Director and Director of Didactic Curriculum, MEDEX Northwest Division of Physician Assistant Studies, Department of Family Medicine, UW Medicine, School of Medicine, University of Washington. Also reviewed by David Zieve, MD, MHA, Bethanne Black, and the A.D.A.M. Editorial team.

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